Diabetic neuropathies

Diabetes is a near-epidemic disease causing many neuropathic presentations most typically involving the sensory and autonomic nervous systems. Some diabetic patients have other superimposed neuropathic processes, requiring careful neurologic, laboratory and metabolic workup. Neuropathy may be the presenting symptom of patients with unrecognized but established diabetes leading to a first-time diagnosis, while others only have impaired glucose tolerance and whether their neuropathy is diabetic is less certain. Many pathogenetic mechanisms have been proposed and tested in animal models. It is considered likely that diabetic neuropathies have different pathogenetic mechanisms and possibly require different therapies.